Health Evaluation Form

Gather your patients' detailed medical histories with a comfy and thorough Health Evaluation Form to give them the first-class health care they deserve. This template allows you to get a complete picture of the patient's well-being, including their current symptoms and complaints, through a series of tick-box choices, which makes it particularly quick and easy to complete. Simply modify your Health Evaluation Form template to your liking by changing its design and fields, integrate it with all required applications, and publish it in just a few clicks to automatically receive submissions right to your mailbox.

Design & Personalize

Use this free template and customize your Report Forms anyway you like. With MightyForms’ drag & drop editor, you can easily add, edit and delete a variety of fields. Include your logo and the colors and theme of your choosing. Any edit you make to the theme of the form is saved to your account, so you can use it on other forms. Add a personalized pop-up or confirmation e-mail to your respondents.

Publish & Integrate

Publish your Report Forms with a click of a button. Just copy and paste the code to embed it on a website, send it to an email list or share it over social media. You can integrate your Report Forms with Google Tag Manager and Google Analytics, that way you can more easily keep track of how well it is performing. You can also integrate your form with thousands of apps through Zapier.

Collect & Share

Keep track of real-time results and views of your forms right on your MightyForms account. Our templates are 100% responsive, so your respondents can fill out your Report Forms from any device. Edit existing entries and download the reports anytime. You can also customize notification emails to be sent to you and members of your team, optimizing your workflow and keeping everyone on the same page.

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